An Approach to Chest Pain

A overview of the diagnostic approach to a patient with acute chest pain, focusing on the life-threatening etiologies of acute coronary syndrome (i.e. an acute MI), pulmonary embolism, aortic dissection, and pneumothorax.

[@altinveseli4646]

Dear Dr. Strong, Thank you very much for these series. You are an incredible teacher and these videos are amazing.

[@eugeneojirigho2330]

Thank you, Dr Strong. I love the systematic approach you take in teaching medicine; makes it a lot easier to follow and remember.

[@hasanraheem5061]

I can not describe how useful this approach is. Thank you so much Dr. STRONG.

[@gheorghealexandrucristian]

Thank you Dr. Strong! You manage to complete my medical knowledge. This is the kind of presentations we need in medical schools. Very logical and well organised.

[@jyotiradityasingh1878]

Thank you sir, "Approach to chest pain" is a major question in our MBBS Exam, and you have helped me in a systematic and algorithmic way.

[@CleAnthony]

You are a real-life hero to students all around the world. Forever grateful, Dr. Strong. God bless you

[@crit-ic]

You are an excellent speaker! I'm liking these series so far by the way!

[@gregorykipp9308]

I like how he presents good tone and well understood!

[@iatrogenicmybad9482]

1st year in clinical medicine taking my time to be as great teacher as Dr.Strong ,one single take no cut, such as astonishing teacher much respect to Dr.Strong

[@dy7023]

Excellent video, so details. Always love watching your videos. Please continue sharing your knowldege!

[@samanthawebb9621]

Dr. Strong, THANK YOU for this very detailed and helpful video!

[@user-is5rh9zc3h]

Thank you dr Strong , bc of you i fell in love with cardiology after it was my least favorite in college , and now i work as an anesthesia nurse in cardiac surgeries

[@monkeylalamonkey]

This is a great framework, thank you!

[@majow]

these approaches are amazing. thank you Dr

[@CushingsSx]

Thank you 🙏 These symptomatic approach DDx algorithms are so good, binge watching 😊

[@VyVy-ks5qj]

thank you Doctor, your lectures are really helpful and easy to remember in clinical practice

[@jamejuliusdilla7998]

Thanks for the clear explanations. Your skills are great.

[@Sjet1996]

Thank you for this Dr Strong, very helpful video!

[@waseemdouna117]

Exactly looking for that stuff. Thanks Dr. ❤️

[@mohammedalkhalaf9189]

Thank you from the bottom of my heart ❤ .. I have Osler exam tomorrow and I hope I will pass...

[@tamerwanees7233]

Thank you very much dr strong.please we need videos for neurological disease for critical care.

[@mohameddalmar5804]

Simple and clear. Thank you.

[@Lanzetti]

As always, a superb class!

[@alexherrmann1989]

Please more videos like this. So helpful. An approach to Abdominal pain

[@sarahmina1442]

He made one!

[@HealthwithVG]

Thank you so much . Dr I just had one request can you please give us the treatment protocol for the comman diseases which we see in day to day practise.

[@Sherirose1]

Brilliant high yield info. Thank you.

[@Dr_feelgood_zw]

Beautiful 🤩 ❤ thank you very much watched this before my Chest pain lecture, super helpful and organised stuff. when at first i saw that big blue busy table, i thought to myself how i was gonna take all that in, but you broke it down into a simple understandable tutorial thank you 🙏 +1 subscription 😊

[@ns687]

Thank you for this!

[@bharathhr897]

No words except thank you

[@sauravshandilya884]

Wonderful approach, learnt a lot

[@bhagawanjadhao3735]

Thank you Dr. Strong

[@waitingforsunshine1740]

Perfect approach&explanation 👍👍👍👍

[@mukizarogers]

Thank you so so much Dr. This has helped me tremendously. Receive my apprectionsXX

[@sarahmina1442]

Thank you! Your videos are making us medically Strong 💪😁

[@vigneshkumars7149]

Very useful Sir. Thank you

[@laurentiu244]

Excellent presentation . Everyone should watch.

[@onlyfighter5669]

Superb dr strong ... Please also post more emergency condition and primary Management....need help full..

[@sunving]

Thank you Dr Strong , If i never ran into your lectures, i would be so out of date on par with layman.

[@Tonnie31]

Excellent video

[@PKR1503]

Thanks for the awesome video!

[@adilsheikh4956]

Very helpful video...

[@t.jcovers2173]

thank you so much!

[@davocreative]

Excellent as always doctor

[@muhammadrafique5042]

V neat and clean lecture ever I seen'

[@aussama3139]

I swear you the best of best

[@Kalemalex]

Thank you Dr

[@janajaber4505]

Amazing video❤

[@ichbinarztin5407]

Danke schön 😊

[@jsv07018]

How can you print those tables ? Those information are very informative.

[@rifqifadma4401]

Thank you

[@guleidali3391]

Thank you so much Sir

[@alizo3]

Thank you so much

[@vanessanwo]

Thanks!

[@catfishBG]

Hi , Dr. Strong , i admire you for what you do ! I want to ask you is CAD defined as a structural heart disease, because the term Structural heart disease is somewhat diverse in different textbooks and I am confused. Thank you .

[@StrongMed]

Ack! I'm so sorry that I didn't see this a year ago! Yes, the term "structural heart disease" is problematic as there is not a universal definition. Even among American cardiologists, the definition may vary a little. As per my cardiologist wife (who I just asked), electrophysiologists generally consider CAD to be under the umbrella of "structural heart disease" irrespective of the presence or absence of LV dysfunction, but some heart failure specialists consider CAD with normal LV function to not be included. Sorry if my use of the term in the video was confusing!

[@charleskim4905]

Dear Dr. Strong Thank you so much for your video series. They are awesome and help with my clinical day-to-day's. I do want to include that when I go through my list of emergent chest pain, I also include Boerhaave syndrome. I believe this syndrome also has a high mortality rate. yours truly, CK

[@StrongMed]

Charles, thanks for your comment! Yes, many people include Boerhaave syndrome, or any form of esophageal rupture more generally, in a framework for chest pain. I left it out in the interest of keeping the list focused on diagnoses that are relatively common. (Boerhaave has an incidence on the order of 1 case/1 million patients/year.) But you are totally right that it has a high mortality, largely due to being a delayed (or entirely missed) diagnosis because it's rare enough that many people don't even think of it in their differential diagnosis.

[@albouq0081]

I don't know how to thank you ♥ my regards from saudi arabia

[@mwebazanoah929]

Thanks Dr

[@adilsheikh4956]

Thank you Sir..

[@zma7565]

I think one important cause that hasn't been included here is oesophageal perforation as it is a life-threatening cause of chest pain.

[@iliyasbaba2743]

Boerhaave syndrome

[@ashlengovender8888]

Amazing!!

[@gamu5154]

thank you!!

[@omjha4079]

You're a legend ❤️

[@hadeedtahir8590]

That was awesome

[@ahmadfaisal3391]

thank you dr,

[@NajmiFakhriy]

Ejalol busuk 🤢

[@mayankaswani5760]

Thank u doctor. Very helpful. Please post more videos on topics- cyanosis, hemoptysis.cough.hepatomegaly splenomegaly , jaundice, ascites,haematemesis etc.

[@StrongMed]

Thanks for the suggestions! Cough and hemoptysis will definitely be covered in the next group of clinical reasoning videos to be posted - hopefully late Feb. GI topics will probably be late spring.

[@sriaz6581]

So helpful

[@alexandremello6913]

Great systematic explanation of the topic. What about pneumonia?

[@StrongMed]

Thanks for the comment! I list pneumonia in the framework, but don't circle back to it when talking about the diagnostic approach because it doesn't commonly present with chest pain as the chief complaint in the same way that some of the other diagnoses do. I'd certainly discuss it more if I made the video longer, but my students have assured me that 15 minutes is the upper limit of their attention span!

[@landonholt7961]

Could you discuss differentiating between anxiety induced chest pain vs. ACS?

[@jerrypotter9070]

Have u published your book?

[@user-rs8kc6iz4v]

you are awesome

[@turkjaddy8752]

very useful. ❤

[@ionicguy4919]

Dr. Strong, thank you for your wonderful lectures. The "relief with nitroglycerin" approach is still used in my ED. Could you elaborate on why this is now outdated and where I can find some information to convey this to my peers? Regards,

[@StrongMed]

Here's a good summary of the evidence: www.ebmconsult.com/articles/relief-of-chest-pain-nitroglycerin-predictive-coronary-artery-disease-cad-or-cardiac-chest-pain

[@medstudywithhf4182]

Thnku sir ♥️

[@husnain2412]

Thank you Sir :-)

[@mmaman6931]

Am I correct in thinking that pancreatitic pain commonly presents as chest pain, and is this presentation rarer than the other GI causes of chest pain (bar oesophageal)?

[@nnekaou4490]

No. Epigastric pain is more pancreatitis. Substernal Pain is more Esophageal issues.

[@dorindragos]

The description of the pain for pulmonary embolism (PE) corresponds to relatively small, peripheral embolism (by contrast to large, central one), which is not really dangerous per se. The large, central PE is the life-threatening one and the chest pain it provokes is not pleuritic, not laterilized and not sharp, but central, diffuse, vaguely defined.

[@StrongMed]

Thanks for bringing up this point! Unfortunately, nuances get dropped when trying to keep these videos concise, but this was probably one that I should have included. I don't know of any data to specifically support this, but I think you are likely correct that the minority of PEs that are central/massive are more likely to present with central vague pain more closely resembling cardiac ischemia. I would hypothesize that the mechanism of such pain may be more related to demand ischemia from high RV afterload than from pleural irritation. In my (thankfully) limited experience with such PEs, they also usually present concurrently with abrupt onset of shock and/or signs of acute RV failure, which helps suggest the diagnosis.However, I wouldn't want to mislead by saying that small, peripheral PEs are not dangerous per se. While it's true that these particular emboli might not be dangerous themselves, they demonstrate that the patient has a hypercoaguable state and may have remaining DVT somewhere with potential for a larger embolism in the near future. So I consider all PEs to be a significant problem, even if they aren't of immediate hemodynamic significance.But overall, I would agree that if one knew a patient to have a pulmonary embolism, it would be more concerning if the patient had poorly localized, non-pleuritic, substernal pain, than if they had lateralized, pleuritic pain.

[@cellbiologyshorts9105]

Is there anything you can do to rule out aortic dissection without doing a CT angio? I often wonder if someone has essentially bought themselves a big dose of radiation if they say answer 'yes' if they have back pain. Does any one use the ADD-RS? (aortic dissection detection risk score)

[@StrongMed]

For patients with contraindications to CTA, echocardiography is done. Some start with a TTE and proceed to TEE. In that approach, if the TTE shows a type A dissection, they proceed directly to the OR. If the TTE shows either a type B dissection, or is inconclusive/negative, they proceed with an emergent TEE. Other clinicians just start with a TEE right off the bat. These options are talked about in a good article in Heart from this month: heart.bmj.com/content/106/3/182 (unfortunately, behind a paywall). Regarding the ADD-RS, I honestly don't know how often it's employed as a strict clinical prediction rule. As a hospitalist, I don't see patients with suspected aortic dissection until either its been ruled out, or unless they develop a major medical complication after surgery for those who "rule in". However, I think the general principles of the ADD-RS are used frequently: pretest probability of dissection depends upon presence of major risk factors, characteristics of the presenting pain, supportive exam findings, and the D-dimer. There is also a huge amount of liability concern when it comes to testing thresholds for dissection - at least in the US. A missed aortic dissection is one of the most feared diagnostic errors in medicine (with a high probability of leading to a malpractice lawsuit), so the threshold for scanning is probably a little too low for the majority of clinicians (understandably so).

[@alecmegherdijian2513]

This guy strong

[@khaireidea2224]

Thank u doctor, can i find the notes please ❤

[@marygarza1596]

But well said dr.☺️

[@drhanzal]

NICE GO ON

[@jjjdjejejj6928]

Thanks Doctors how do I overcome that pain

[@StrongMed]

I'm sorry, but I can't give specific, individualized medical advice here. I recommend speaking to your own doctor about your symptoms.

[@kimo5059]

Does cardiac tamponade not cause acute chest pain?

[@StrongMed]

No, surprisingly it usually doesn't. The most common presenting symptom of subacute tamponade (the most common type) is dyspnea. Chest pain is occasionally seen in patients who develop acute tampoande from things like trauma, aortic dissection, and accidental cardiac perforation during an invasive procedure. However, in those cases, it isn't the tamponade itself (i.e. excess fluid in the pericardial space, impairing venous return and diastolic filling) that's necessarily causing the chest pain, but rather another, primary condition causing both the chest pain and the tamponade.

[@derozerr4856]

Does.Aortic Aneurysm cause Chest pain?

[@StrongMed]

Not typically, unless it ruptures, is infected, or there's an associated aortic dissection. But if the aortic aneurysm is just sitting there, slowly growing over years, it's usually almost always asymptomatic.

[@varundurge]

What is MSK?

[@StrongMed]

Musculoskeletal. I know it's not a very logical acronym, and now that I think about it, while the term is widely used in the US, I can imagine it not being used much in the rest of the world.

[@augmented6020]

I LIKE THIS GUY

[@user-fg6nc9mc8x]

Note please. Why are chest pain etc.? It is often caused by problems with blood circulation (slow or fast) due to congenital coldness, hypothermia (cold food, air conditioner, etc.), aging or stress. * It is a priority to receive medical care from specialist hospitals and receive accurate diagnosis. However, in addition to hospital prescriptions, please refer to the supplement below. Symptoms: Headache, migraine, dizziness, fainting, eye pain, congestion, facial convulsions, eye tremor, etc. 2) When the blood circulation is not good due to stomach and intestines Symptoms: Abdominal pain. Diarrhea, drowsiness, crawling, constipation, gas, gastritis, esophagitis, etc. 3) Other symptoms: chest pain and throbbing, arrhythmia, swelling of the hands and feet, bruises on the body, hands and feet, It is a symptom that often occurs when the blood that the heart releases does not easily circulate in the body because the blood circulation does not occur. If the problem of blood circulation causes an abnormality in your body, what should you do to promote blood circulation? 1. Scratch your hands palms firmly. It is the easiest way to circulate blood. For example, you can do this only when you are feeling a bit deeper. 2. If you have blood circulation problems such as dizziness, headache, sudden chest pain, or chest pain, follow your hands (above the stop and fifth fingernail) and breathe properly to relieve symptoms. Depending on the condition, you may have to pull your entire finger. If the problem still can not be solved, use the same method on the toe claw. In addition, the second and third joints of the hands are stabbed twice with a syringe needle, respectively, and finger blood is passed through to help relieve various symptoms caused by blood circulation problems. => The effect of promoting blood circulation is great, and it is the most effective way to alleviate symptoms when there are abnormal blood circulation such as headache, dizziness, chest pain, abdominal pain. 3. If you warm your stomach more than 30 minutes a week for three times a week, it will have a lot of effect. As the feet are called the second heart, the feet are warmed It can ease the burden on the heart and promote blood circulation. It is to follow the teachings of oriental medicine (the head is cold and the feet are warm). * The effect of footbath - calming the sympathetic nerves to sleep and take a good night's sleep. - Promotes blood circulation (relieves constipation and improves stomach and intestinal disease) - Swelling of legs and calves is lost and muscles of body are loosened. - It is easy to remove waste materials in the body (improve the skin troubles such as acne, etc.) - If sweat is enough, the immunity is improved 5 times to prevent various illnesses (improvement to health constitution) 4. Smile for more than 10 minutes alone in the car. If you do not get a smile, think about it for 10 minutes or more. If you get a smile, please forgive and smile for over 10 minutes. If you do not want to cry, sing your favorite song to your belly so you can relax. Aristotle says that the door of happiness is a laugh, and if we laugh at our proverb, we will be blessed, and we will be happy if we smile at the same time. I can see that he is next to me. There is also a study that says that if you smile unconditionally for 10 minutes without reason, you are happy for 2 hours. 5. Exercise your own workout (maintain your body temperature by increasing your muscle mass) Enjoy a lot of sunshine (improve your depression and make your bones harder). Breathe deeply into your belly to warm your stomach by warm air outside. (Effective when you have a cold after eating a cold food) * Good food & beverage recommendation: Honey black garlic / honey garlic, onion wine, wormwood, ginger, burdock tea, vinegar, tomato etc. * Toe tip (in chair or lie) and palm end wrist stroke are also good for health such as normal blood circulation ... * Turtle neck (date neck) problem is much improvement when we cut car muzzle. Neck pain is effective when you press the middle finger of the sore throat's hand backward and press the finger of the fingertip side and the third finger of the fingertip. * If you have muscular bunching (fence), it is effective and you usually have to do it at home. It can also help you relax your shoulder and back muscles, massage or stretch stretch. * If you have back pain in your arms and legs in a clear posture to reach your ears to repeat the clapping of the wrist and lean to lift the upper body is helpful. * If the mouse on the toe of the left leg is the first node of the left hand, the left leg calf is the mouse second finger of the left hand. If the mouse is on the left thigh, the third finger of the left finger is stabbed It will help if you give a little blood ... (right hand if it is right)Many people will be able to solve the inconvenience of life by this measure alone. * PS: If you use the above method and do not have any effect, I hope that you will receive a specialist examination and complete your recovery ... < Life is a play that plays the role of each person in the stage of the world.If there is a goal of life and living so, even if it is not done now, it becomes the driving force of life even if it is difficult to achieve.It may be difficult tomorrow even if it is difficult today.Anyone I am worried but I have lived my life because I lived with my thoughts differently. Love yourself, love your own scarce and ugly self. I can love others who are scarce and lacking when I can not love myself so much and I can love myself and others I now love myself and love my family and neighbors It is. So I also add these articles. 1. Smile unconditionally. If you smile like crazy like a crazy person, happiness will be next to you. 2. Look for health. Mentally (laughter), physically (movement), materially (labor) 3. Love. 4. Thank yourself, your family, and your neighbors. Please forgive me for breathing. Refuse people who are wrong with me (if you humiliate a person who is hated in the car for 10 minutes, you will get a smile, please forgive). Reflect on what I have done wrong and apologize with courage. 5. Be happy. If you live like above, you will live happily. If there is only one person who loves me, cherish yourself for him. It is an experience that has lived the world as a person who sent youth. >>> Have a happy and healthy day with laughter. >>> Individuals must be healthy to have a healthy family, home to be healthy, society to be healthy, society to be healthy, and the nation to be healthy.

[@marygarza1596]

Too many hard words ‘ never heard of

[@amadoubarrybarry7964]

Doctor can you please help me i have chest pain

[@StrongMed]

I'm sorry, but I cannot offer specific, individualized medical advice here. I recommend speaking with your own physician about your concern, or considering seeking emergency care if your symptoms are of recent onset and/or your physician is not available.

[@HussainAli-ne3ms]

i love you

[@manjitkand5391]

Nice shirt

[@mohammad.shokrolahi]

:)

[@mfoster90]

WORLD Teaching Credentials? Layman terms boo cuz based on my KZbin search I shouldn't have access to a MEDICAL UNIVERSITY without paying $$$$$$$$$$$$$. It's reckless

[@StrongMed]

I'm not sure I understand. Are you suggesting that it's reckless to provide university-level educational materials online for free?

[@adnanraza5764]

Thank you so much

[@corisutton8406]

Thanks!